MDS 3.0 Resident Assessment Manual Chapter 1 Change ... - AANAC
MDS 3.0 Resident Assessment Manual Chapter 1 Change ... - AANAC
MDS 3.0 Resident Assessment Manual Chapter 1 Change ... - AANAC
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Track <strong>Change</strong>s<br />
from <strong>Chapter</strong> 1 V1.10<br />
to <strong>Chapter</strong> 1 V1.11<br />
<strong>Chapter</strong> Section Page <strong>Change</strong><br />
— — 1-2 IFMC Telligen<br />
• Gloria Batts<br />
• Debra Weiland, BSN, RN<br />
• Jean Eby, BS<br />
• Debra Cory, BS<br />
• Kathy Langenberg, RN<br />
— — 1-3 RTI International<br />
• Roberta Constantine, RN, PhD<br />
• Rajiv Ramakrishnan, BA<br />
• Nathaniel Breg, BA<br />
• Karen Reilly, Sc.D.<br />
— — 1-4 Questions regarding information presented in this <strong>Manual</strong> should<br />
be directed to your State’s RAI Coordinator. Please continue to<br />
check our web site for more information at:<br />
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-<br />
<strong>Assessment</strong>-<br />
Instruments/NursingHomeQualityInits/<strong>MDS</strong>30RAI<strong>Manual</strong>.htmlhtt<br />
p://www.cms.gov/Medicare/Quality-Initiatives-Patient-<br />
<strong>Assessment</strong>-<br />
Instruments/NursingHomeQualityInits/Downloads/<strong>MDS</strong>30Appen<br />
dix_B.pdf .<br />
1 1.3 1-7 • Consumer Access to Nursing Home Information.<br />
Consumers are also able to access information about every<br />
Medicare- and/or Medicaid-certified nursing home in the<br />
country. The Nursing Home Compare tool<br />
(http://www.medicare.gov/nursinghomecompare/http://www.m<br />
edicare.gov/NHCompare) provides public access to nursing<br />
home characteristics, staffing and quality of care measures for<br />
certified nursing homes.<br />
1 1.8 1-16,<br />
1-17<br />
&<br />
I-18<br />
PRIVACY ACT STATEMENT – HEALTH CARE RECORDS<br />
Long Term Care-Minimum Data Set (<strong>MDS</strong>) System of Records revised<br />
04/28/2007<br />
PRIVACY ACT STATEMENT – HEALTH CARE RECORDS (7/14/2005)<br />
(Issued: 9-6-12, Implementation/Effective Date: 6-17-13)<br />
THIS FORM PROVIDES YOU THE ADVICE REQUIRED BY THE<br />
PRIVACY ACT OF 1974 (5 USC 552a). THIS FORM IS NOT A CONSENT<br />
FORM TO RELEASE OR USE HEALTH CARE INFORMATION<br />
PERTAINING TO YOU.<br />
THIS FORM IS NOT A CONSENT FORM TO RELEASE OR USE HEALTH<br />
CARE INFORMATION PERTAINING TO YOU.<br />
1. AUTHORITY FOR COLLECTION OF INFORMATION,<br />
October 2013 Page 1
Track <strong>Change</strong>s<br />
from <strong>Chapter</strong> 1 V1.10<br />
to <strong>Chapter</strong> 1 V1.11<br />
<strong>Chapter</strong> Section Page <strong>Change</strong><br />
INCLUDING SOCIAL SECURITY NUMBER AND WHETHER<br />
DISCLOSURE IS MANDATORY OR VOLUNTARY. Authority for<br />
maintenance of the system is given under Sections 1102(a), 1819(b)(3)(A),<br />
1819(f), 1919(b)(3)(A), 1919(f) and 1864 of the Social Security Act.<br />
The system contains information on all residents of long-term care (LTC)<br />
facilities that are Medicare and/or Medicaid certified, including private pay<br />
individuals and not limited to Medicare enrollment and entitlement, and<br />
Medicare Secondary Payer data containing other party liability insurance<br />
information necessary for appropriate Medicare claim payment.<br />
Medicare and Medicaid participating LTC facilities are required to conduct<br />
comprehensive, accurate, standardized and reproducible assessments of each<br />
resident's functional capacity and health status. To implement this requirement,<br />
the facility must obtain information from every resident. This information is<br />
also used by the Centers for Medicare & Medicaid Services (CMS) to ensure<br />
that the facility meets quality standards and provides appropriate care to all<br />
residents. 42 CFR §483.20, requires LTC facilities to establish a database, the<br />
Minimum Data Set (<strong>MDS</strong>), of resident assessment information. The <strong>MDS</strong> data<br />
are required to be electronically transmitted to the CMS National Repository.<br />
Because the law requires disclosure of this information to Federal and State<br />
sources as discussed above, a resident does not have the right to refuse consent<br />
to these disclosures. These data are protected under the requirements of the<br />
Federal Privacy Act of 1974 and the <strong>MDS</strong> LTC System of Records.<br />
1. AUTHORITY FOR COLLECTION OF INFORMATION<br />
INCLUDING SOCIAL SECURITY NUMBER (SSN)<br />
Sections 1819(f), 1919(f), 1819(b)(3)(A), 1919(b)(3)(A), and 1864 of the<br />
Social Security Act.<br />
2. PRINCIPAL PURPOSES OF THE SYSTEM FOR WHICH<br />
INFORMATION IS INTENDED TO BE USED. The primary purpose of<br />
the system is to aid in the administration of the survey and certification, and<br />
payment of Medicare/Medicaid LTC services which include skilled nursing<br />
facilities (SNFs), nursing facilities (NFs) and non-critical access hospitals<br />
with a swing bed agreement.<br />
Information in this system is also used to study and improve the effectiveness<br />
and quality of care given in these facilities. This system will only collect the<br />
minimum amount of personal data necessary to achieve the purposes of the<br />
<strong>MDS</strong>, reimbursement, policy and research functions.<br />
2. PRINCIPAL PURPOSES FOR WHICH INFORMATION IS<br />
INTENDED TO BE USED<br />
This form provides you the advice required by The Privacy Act of 1974.<br />
The personal information will facilitate tracking of changes in your<br />
health and functional status over time for purposes of evaluating and<br />
assuring the quality of care provided by nursing homes that participate in<br />
Medicare or Medicaid.<br />
3. ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM.<br />
The information collected will be entered into the LTC <strong>MDS</strong> System of<br />
Records, System No. 09-70-0528. This system will only disclose the minimum<br />
amount of personal data necessary to accomplish the purposes of the disclosure.<br />
Information from this system may be disclosed to the following entities under<br />
October 2013 Page 2
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from <strong>Chapter</strong> 1 V1.10<br />
to <strong>Chapter</strong> 1 V1.11<br />
<strong>Chapter</strong> Section Page <strong>Change</strong><br />
specific circumstances (routine uses), which include:<br />
(1) To support Agency contractors, consultants, or grantees who have been<br />
contracted by the Agency to assist in accomplishment of a CMS<br />
function relating to the purposes for this system and who need to have<br />
access to the records in order to assist CMS;<br />
(2) To assist another Federal or state agency, agency of a state government,<br />
an agency established by state law, or its fiscal agent for purposes of<br />
contributing to the accuracy of CMS’ proper payment of Medicare<br />
benefits and to enable such agencies to fulfill a requirement of a<br />
Federal statute or regulation that implements a health benefits program<br />
funded in whole or in part with Federal funds and for the purposes of<br />
determining, evaluating and/or assessing overall or aggregate cost,<br />
effectiveness, and/or quality of health care services provided in the<br />
State, and determine Medicare and/or Medicaid eligibility;<br />
(3) To assist Quality Improvement Organizations (QIOs) in connection<br />
with review of claims, or in connection with studies or other review<br />
activities, conducted pursuant to Title XI or Title XVIII of the Social<br />
Security Act and in performing affirmative outreach activities to<br />
individuals for the purpose of establishing and maintaining their<br />
entitlement to Medicare benefits or health insurance plans;<br />
(4) To assist insurers and other entities or organizations that process<br />
individual insurance claims or oversees administration of health care<br />
services for coordination of benefits with the Medicare program and<br />
for evaluating and monitoring Medicare claims information of<br />
beneficiaries including proper reimbursement for services provided;<br />
(5) To support an individual or organization to facilitate research,<br />
evaluation, or epidemiological projects related to effectiveness, quality<br />
of care, prevention of disease or disability, the restoration or<br />
maintenance of health, or payment related projects;<br />
(6) To support litigation involving the agency, this information may be<br />
disclosed to The Department of Justice, courts or adjudicatory bodies;<br />
(7) To support a national accrediting organization whose accredited<br />
facilities meet certain Medicare requirements for inpatient hospital<br />
(including swing beds) services;<br />
(8) To assist a CMS contractor (including but not limited to fiscal<br />
intermediaries and carriers) that assists in the administration of a CMSadministered<br />
health benefits program, or to a grantee of a CMSadministered<br />
grant program to combat fraud, waste and abuse in<br />
certain health benefit programs; and<br />
(9) To assist another Federal agency or to an instrumentality of any<br />
governmental jurisdiction within or under the control of the United<br />
States (including any state or local governmental agency), that<br />
administers, or that has the authority to investigate potential fraud,<br />
waste and abuse in a health benefits program funded in whole or in<br />
October 2013 Page 3
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from <strong>Chapter</strong> 1 V1.10<br />
to <strong>Chapter</strong> 1 V1.11<br />
<strong>Chapter</strong> Section Page <strong>Change</strong><br />
part by Federal funds.<br />
3. ROUTINE USES<br />
The primary use of this information is to aid in the administration of the<br />
survey and certification of Medicare/Medicaid long-term care facilities<br />
and to improve the effectiveness and quality of care given in those<br />
facilities. This system will also support regulatory, reimbursement,<br />
policy, and research functions. This system will collect the minimum<br />
amount of personal data needed to accomplish its stated purpose.<br />
The information collected will be entered into the Long-Term Care<br />
Minimum Data Set (LTC <strong>MDS</strong>) system of records, System No. 09-70-<br />
1517. Information from this system may be disclosed, under specific<br />
circumstances (routine uses), which include: To the Census Bureau and<br />
to: (1) Agency contractors, or consultants who have been engaged by the<br />
Agency to assist in accomplishment of a CMS function, (2) another<br />
Federal or State agency, agency of a State government, an agency<br />
established by State law, or its fiscal agent to administer a Federal health<br />
program or a Federal/State Medicaid program and to contribute to the<br />
accuracy of reimbursement made for such programs, (3) to Quality<br />
Improvement Organizations (QIOs) to perform Title XI or Title XVIII<br />
functions, (4) to insurance companies, underwriters, third party<br />
administrators (TPA), employers, self-insurers, group health plans, health<br />
maintenance organizations (HMO) and other groups providing<br />
protection against medical expenses to verify eligibility for coverage or<br />
to coordinate benefits with the Medicare program, (5) an individual or<br />
organization for a research, evaluation, or epidemiological project related<br />
to the prevention of disease of disability, or the restoration of health, or<br />
payment related projects, (6) to a member of Congress or congressional<br />
staff member in response to an inquiry from a constituent, (7) to the<br />
Department of Justice, (8) to a CMS contractor that assists in the<br />
administration of a CMS-administered health benefits program or to a<br />
grantee of a CMS-administered grant program, (9) to another Federal<br />
agency or to an instrumentality of any governmental jurisdiction that<br />
administers, or that has the authority to investigate potential fraud or<br />
abuse in a health benefits program funded in whole or in part by Federal<br />
funds to prevent, deter, and detect fraud and abuse in those programs,<br />
(10) to national accrediting organizations, but only for those facilities<br />
that these accredit and that participate in the Medicare program.<br />
4. EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION.<br />
The information contained in the LTC <strong>MDS</strong> System of Records is generally<br />
necessary for the facility to provide appropriate and effective care to each<br />
resident.<br />
If a resident fails to provide such information, e.g. thorough medical history,<br />
inappropriate and potentially harmful care may result. Moreover, payment for<br />
services by Medicare, Medicaid and third parties, may not be available unless<br />
the facility has sufficient information to identify the individual and support a<br />
claim for payment.<br />
NOTE: <strong>Resident</strong>s or their representative must be supplied with a copy of the<br />
notice. This notice may be included in the admission packet for all new nursing<br />
home admissions, or distributed in other ways to residents or their<br />
representative(s). Although signature of receipt is NOT required, providers may<br />
request to have the <strong>Resident</strong> or his or her Representative sign a copy of this<br />
notice as a means to document that notice was provided and merely<br />
acknowledges that they have been provided with this information.<br />
4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY<br />
October 2013 Page 4
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from <strong>Chapter</strong> 1 V1.10<br />
to <strong>Chapter</strong> 1 V1.11<br />
<strong>Chapter</strong> Section Page <strong>Change</strong><br />
AND EFFECT ON INDIVIDUAL OF NOT PROVIDING<br />
INFORMATION<br />
For Nursing Home residents residing in a certified Medicare/Medicaid<br />
nursing facility the requested information is mandatory because of the<br />
need to assess the effectiveness and quality of care given in certified<br />
facilities and to assess the appropriateness of provided services. If the<br />
requested information is not furnished the determination of beneficiary<br />
services and resultant reimbursement may not be possible.Your signature<br />
merely acknowledges that you have been advised of the foregoing. If<br />
requested, a copy of this form will be furnished to you.<br />
______________________________<br />
Signature of <strong>Resident</strong> or Sponsor<br />
__________________<br />
Date<br />
October 2013 Page 5